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Prevention of acute complications after percutaneous transluminal coronary angioplasty
M G Bourassa1, L Schwartz, J Lespérance
1Department of Medicine and Radiology, Montreal Heart Institute, Canada.
Insights
Short-term antiplatelet therapy with aspirin and dipyridamole significantly reduces the risk of periprocedural myocardial infarction during coronary angioplasty. This combination therapy is recommended for patients undergoing the procedure.
Area of Science:
- Cardiology
- Interventional Cardiology
- Pharmacology
Background:
- Percutaneous transluminal coronary angioplasty (PTCA) carries risks of periprocedural complications, including myocardial infarction.
- Effective strategies are needed to prevent these major adverse events during and after PTCA.
Purpose of the Study:
- To evaluate the efficacy of an aspirin-dipyridamole combination in preventing major complications after PTCA.
- To assess the impact of this antiplatelet therapy on periprocedural myocardial infarction (MI).
Main Methods:
- A randomized, double-blind, placebo-controlled multicenter trial involving 376 patients.
- Patients received either aspirin-dipyridamole combination (n=187) or placebo (n=189) starting 24 hours before PTCA.
- Outcomes including periprocedural death, non-fatal MI (Q wave and non-Q wave), and need for emergency revascularization were monitored.
Main Results:
- No periprocedural deaths occurred in either group.
- Overall periprocedural non-fatal MI occurred in 9.0% of patients.
- Q wave MI was significantly lower in the aspirin-dipyridamole group (1.6%) compared to placebo (6.9%, p=0.0113).
- The combined incidence of Q and non-Q wave MI was 4.8% with antiplatelet therapy versus 13.2% without (p=0.0044).
Conclusions:
- Short-term antiplatelet therapy with aspirin-dipyridamole before and after PTCA markedly reduces the incidence of periprocedural myocardial infarction.
- This therapeutic approach is recommended for patients undergoing PTCA, provided no contraindications exist.
Abstract:
The prevention of major complications occurring during or early after percutaneous transluminal coronary angioplasty was evaluated in 376 patients in a randomized, double-blind, placebo-controlled multicenter trial. Starting 24 hours before angioplasty, 187 patients received an aspirin-dipyridamole combination and 189 were given placebo. There were no periprocedural deaths. Periprocedural non-fatal myocardial infarction was diagnosed in 34 patients (9.0%). Q wave myocardial infarction occurred in 16 patients: 3 (1.6%) in the aspirin-dipyridamole group and 13 (6.9%) in the placebo group (p = 0.0113). Non-Q wave myocardial infarction occurred in 18 patients: 6 (3.2%) in the active drug group and 12 (6.3%) in the placebo group (p = 0.1538). Emergency myocardial revascularization was performed in 9 patients in each treatment arm. Q wave myocardial infarction occurred following revascularization in 5 patients (55.5%) in the placebo group and in only 2 (22.2%, p = 0.1670) in the aspirin-dipyridamole group. Thus the incidence of periprocedural Q and non-Q wave myocardial infarction is high in patients not on antiplatelet therapy (13.2%) and is markedly lower in those on the aspirin-dipyridamole combination (4.8%, p = 0.0044). Short-term antiplatelet therapy before and after angioplasty can be recommended for patients who do not have contraindications to this medication.